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2016 PQRS Measures for Occupational Therapy

January 3, 2016 0 Comments

There is no change in 2016 PQRS measures reporting for occupational therapy wordle 2for claims based reporting.  As the new year begins occupational therapists, much like physical therapists, may find themselves in one of three situations regarding PQRS reporting:  1) Successful reporting in 2014, and therefore no reductions to Medicare payments in 2016. 2) Notification that 2014 reporting was unsuccessful and therefore a 2% payment penalty applies to Medicare reimbursements this year. 3) Never having reported, which could mean a 2% reduction in 2017 or alternatively you are a new provider and eligible to report in 2016.  If you are an occupational therapist this will provide a brief overview, however, if you find that you need more information be sure to sign up for this complimentary webinar: 2016 Medicare Changes: What Every Therapist Needs to Know.

2016 PQRS Measures Reporting Options for OT

Only occupational therapists in private practice are eligible for PQRS measures reporting.  Occupatonal therapists in hospital departments, skilled facilities, rehab agencies, home health agencies and CORFs are not eligible providers (EP) for the purpose of PQRS.  Occupational therapists in private practice have the option of reporting via a registry or via claims.  Those reporting via registry may also select the group practice reporting option (GPRO).  If you are reporting via a registry there are also additional required measures.  CMS provides a listing of qualified registries (2015) including FOTO.  Occupational therapists that use the GPRO are also eligible to use the Chronic Care Measures Group.

The easiest way for occupational therapists in private practice to get started is via claims based reporting. The table below lists the individual measures that are required for OT claims based reporting.  CMS requires that reporting be completed on nine (9) measures, and there are 9 applicable measures, therefore all must be completed per the measure specifications.  Be sure to read through the CMS PQRS measure specifications so that your documentation and coding are compliant.  Once you have your bearings on PQRS be sure to try out the CMS online interactive tool.

2016 PQRS Occupational Therapy Measures

Measure #Measure Description
#128Preventive Care and Screening: BMI Screening and Follow-up
#130Documentation and Verification of Current Medications in the Medical Record
#131Pain Assessment & Follow-Up
#134Screening for Clinical Depression & Follow-Up Plan
#154Falls: Risk Assessment
#155Falls: Plan of Care
#181Elder Maltreatment Screen & Follow-Up Plan
#182Functional Outcome Assessment
#226Tobacco Use: Screening & Cessation Intervention
Table Note: Select all nine 2016 codes for OT claims based reporting. Be sure to read 2016 measure specifications for each code to ensure compliance in reporting.


Are you ready for successful PQRS reporting in 2016?  Do you have a 2% payment reduction this year and hope to avoid a PQRS 2% payment penalty for 2017 by successfully reporting this year?  Do you need more information on successful PQRS reporting?  Do you understand the reporting requirements for each measure?

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Nancy Beckley

Nancy J. Beckley MS, MBA, CHC: President-Nancy Beckley & Associates LLC. Compliance outsourcing, risk assessment, compliance plans, compliance training, auditing, due diligence, investigation support for therapy providers.

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